Gonorrhea

Definition

• Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.

• It primarily infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in both men and women.

• It can also affect the mucous membranes of the mouth, throat, eyes, and rectum.

Gonorrhea bacteria are represented, attacking the inflamed areas

Etiology

1. Causative Agent: Neisseria gonorrhoeae, a gram-negative diplococcus bacterium.

2. Transmission: Spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. It can also be transmitted from mother to child during childbirth.

Pathogenesis

1. Attachment: N. gonorrhoeae attaches to epithelial cells of mucous membranes using pili (hair-like structures).

2. Invasion: The bacteria invade the epithelial cells and multiply.

3. Immune Evasion: N. gonorrhoeae produces proteins that inhibit immune responses and prevent destruction by neutrophils and macrophages.

4. Inflammation: The infection triggers an inflammatory response, leading to symptoms.

Signs and Symptoms

1. In Men:

• Urethritis: Inflammation of the urethra causing a burning sensation during urination.

• Discharge: White, yellow, or green discharge from the penis.

• Epididymitis: Painful swelling of the epididymis (a tube at the back of the testicles).

2. In Women:

• Cervicitis: Inflammation of the cervix causing vaginal discharge and bleeding between periods.

• Urethritis: Burning sensation during urination.

• Pelvic Pain: Pain in the lower abdomen, often associated with pelvic inflammatory disease (PID).

3. Rectal Gonorrhea:

• Discharge, anal itching, soreness, bleeding, and painful bowel movements.

4. Throat Gonorrhea (Pharyngeal Infection):

• Sore throat, swollen lymph nodes, and sometimes fever.

5. Eye Infection (Conjunctivitis):

• Redness, pain, and discharge from the eyes, more common in newborns.

Complications

Untreated Gonorrhea:

1. In Men: Epididymitis, prostatitis, and infertility.

2. In Women: Pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and infertility.

3. Disseminated Gonococcal Infection (DGI): Bacteria spread through the bloodstream, causing arthritis, tenosynovitis, and dermatitis.

4. In Newborns: Ophthalmia neonatorum, a severe eye infection that can lead to blindness.

Diagnosis

1. NAAT (Nucleic Acid Amplification Test): The most sensitive test, used on urine samples or swabs from the affected area (urethra, cervix, rectum, or throat).

2. Culture: Bacterial culture from samples, useful for antibiotic sensitivity testing.

3. Gram Stain: Microscopic examination of stained discharge samples, particularly effective in men with symptomatic urethritis.

Treatment

Antibiotics:

• Dual Therapy: Typically involves a single intramuscular injection of ceftriaxone (500 mg) combined with oral azithromycin (1 g).

• Alternatives: If ceftriaxone is unavailable, gentamicin plus azithromycin or doxycycline may be used.

• Test-of-Cure: Follow-up testing to ensure the infection is fully eradicated, particularly in cases of persistent symptoms or known antibiotic resistance.

Partner Notification and Treatment:

• Sexual partners should be notified, tested, and treated to prevent reinfection and further spread of the disease.

Preventive Measures:

1. Safe Sex Practices: Consistent and correct use of condoms.

2. Regular Screening: Particularly for sexually active individuals with multiple partners or those in high-risk groups.

3. Education and Awareness: Informing people about the risks, symptoms, and prevention of gonorrhea.

Complications of Untreated Gonorrhea

1. Pelvic Inflammatory Disease (PID): In women, can cause chronic pain, ectopic pregnancy, and infertility.

2. Epididymitis: In men, leading to infertility.

3. Disseminated Gonococcal Infection (DGI): Can cause severe joint infections, endocarditis, and meningitis.

4. Newborn Complications: Severe eye infections leading to blindness.